Learning to walk, hold a crayon, or use a cup and spoon comes naturally to most infants and toddlers. Some, though, struggle with such basic developmental skills and need the professional talents of occupational therapists like Maria Elina Santisteban '01.

Based in New York City, Santisteban specializes in early intervention, working with children ranging in age from newborn to three years old. The work is challenging, she says, often involving the children of impoverished families or parents who are drug abusers, those with Down syndrome, and others suffering from physical ailments. Yet the rewards are substantial.

Santisteban with clients in manhattan

Typically, about 40 percent of Santisteban's work is direct treatment, which includes teaching the child how to perform basic movements. She also educates the parents. Santisteban is in big demand in her field, especially because, as a native of Argentina, she is bilingual and has an easier time connecting with the many Spanish-speaking families living in areas like Washington Heights, Harlem, and Spanish Harlem. "Some of the families I work with speak no English and they've been unable to communicate with other therapists," she says. "I can explain what I am doing with the child and show them how to continue the work I am doing, because success with the child depends on that." Also, she notes, she is able to educate parents in their own language about their rights and about the services available to them.

Santisteban currently works as an independent contractor, obtaining clients through private early-intervention agencies that evaluate very young children and determine the level of therapy required for each. At this point she's juggling a caseload of 18 children. "With clients at this age the occupational therapy is centered on play," she says. "I assess fine-motor and gross-motor skills from head to toe." Constructive "play" activities include holding a Cheerio with the thumb and index finger, finger painting, and working on puzzles. Gross-motor-skill activities may focus on crawling, rolling over, or reaching for an object.

The story of her two years of work with a girl, starting at age four months, illustrates what a difference a good OT can make. This child, who along with her twin brother was born three months prematurely, was abnormally delayed in her motor-skills development. Santisteban used a hands-on approach called neurodevelopmental treatment, focusing on different parts of the child's tiny body to encourage greater movement. The process included supporting the child's hips to facilitate sitting, stroking her back lightly to increase trunk control, and touching her side to induce rolling over. "The idea is to show them the movement without doing it for them," Santisteban says.

This child, now nearly three, "is brilliant," her therapist says. "She's walking, running, completing puzzles. She is ready for preschool, which is great."

Santisteban explains that while physical therapy typically uses rote exercises designed to rehabilitate after an injury, OT is more flexible, concentrating on specific skills need to perform a task, and is applied differently according to age group. "You have to keep in mind the 'occupation' of the client. For a young child that is play," says Santisteban. "The idea is to help the child be able to do the things that others in the same age group can do."

Santisteban was among the first graduates of Ithaca's five-year master's degree program in occupational therapy. She completed an internship at a pediatric hospital in Birmingham, England, passed a certification exam, and hit the ground running in New York City two years ago.

Watching a young child learn a new skill makes all the hard work worthwhile, she says: "Most of them make progress slowly but surely. I feel like I can make a difference in very young children's lives and help them prepare to do well in school. Often I have been with these children for so long that the parents don't want to let me go, but it's good that I am leaving them -- good that they no longer need me."